Guest editorial: Response to today's QotD

Today's quote of the day has prompted a lengthy response from M. DeMuren, which I publish here with permission:

Back in the day (presumably in the time when the article would have been called, 'Our culture, look how much there is'), my betters taught me that unhappiness is a state of emotion/feeling, and is experienced by all sentient beings at various times. Conversely, also that depression was all about thought processes, and not entirely tied to an emotional state, i.e., depressed people didn't feel unhappy all the time, but quite possibly more often than someone who wasn't depressed.

In those days, we thought that unhappiness was something that you either 'stiff-upper-lipped' through, or fixed by 'get-off-your-ass-and-do-something-about-it' . . . er . . . proactive management. Depression, on the other hand, was handled very differently, as it was thought to be caused by faulty mental processes. The party line was that the only way to successfully treat depression was through medication (as a crutch to support you while you got on with feeding your children, etc.) and therapy (to teach new long-term thought patterns). To only participate in one aspect of the treatment was setting yourself up for failure, as the drugs were needed to adjust the chemical processes in the brain, allowing a patient to successfully break out of the patterns causing inability to deal with life. With the help of a trained professional, the patient learned coping skills, recognition of internal inconsistencies (aka "Am I on crack?"), explored their social safety nets, and eventually, created their own monitoring system so that they could see when they were losing control over themselves.

Back in the day, there was a hope expressed to new patients that they would be able to stop taking the drugs and stop going to therapy, having learned the tools that they need to survive/flourish.

However.

I have been told by a multitude of health professionals that today's patient does not wish to change their lifestyles in any way. It is this disinclination towards change which leads firstly to the need to thin blood and adjust insulin and control cholesterol, etc., and later, to the practice of popping a pill or pushing a needle into a vein while continuing to not make any lifestyle modifications. So, as there are diabetics still 60 lbs. overweight, keeping themselves from coma by a needle with nary a scheduled workout, there are depressed people popping a Paxil daily instead of hauling themselves to a professional to discuss why they wish they could accidentally get hit by a bus. Both groups, though admittedly alive, are no better off in six months, having done no work on the underlying foundational problems.

And so, I see three groups of people: the ill, their doctors, and the drug companies. The ill, reportedly, want tomorrow to be easier/more comfortable/happier than today. Their doctors want the patient to be somewhere other than in their offices. The drug companies want their drugs prescribed now, and forever.

There are two pathways, one with hard work, one without:

1) The work-free path leaves the sick still sick, the doctor unaffected, and is a steady stream of income for the drug company.

2) The hard-work path improves the lot of the sick, is still neutral for the doctor, and causes a negative financial impact for the drug company.

Interestingly, you'll note that the doctor is not affected one way or another by the patient's choices, except perhaps in a warm fuzzy way if s/he still has 'the passion'. This leaves the influences on the decision down to the patient and the drug company.

The drug company can't force the patient to take the pills forever, but they can market the enticing idea of a 'perfect life', available in pill form. Due to the current lax government regulations, there is no requirement for 'truth in advertising', and this means that the marketing can target both the mentally ill through general media, and the doctor through incentives and studies commissioned by the manufacturer.

This leaves us with the patient. For improvement, the patient has to want to be different, and not just on the surface ("I went to work today and didn't spend 10 minutes crying on the floor before I left"). They have to want to be different so badly that they're willing to work at it, maybe for years. This willingness to undertake hard and uncomfortable work is the crux of the matter.

If the patient isn't committed to full treatment, then they place the doctor in the position of choosing to either ease some of the symptoms with drugs, or leave the person suffering with their depression. With the Hippocratic oath in their minds, they choose to 'band-aid' and thereby alleviate some of the suffering, even though they're not actually improving the condition.

So, I do not accept that it is the media's fault for removing 'unhappy' from our collective vocabulary, nor the doctor's for over-prescribing 'happy pills', none of which actually make people happy. If we're looking at blame, I place it squarely at the feet of the individual. There are many depressed people out there, but I've seen no proof that anyone who has taken pills for their depression become less depressed as a result. They don't kill themselves, and remain (somewhat) functional members of society, but they are still depressed. If you take their pills away, they still have the baseline condition, because nothing has changed. If the individual is interested in improvement of their condition, they themselves must work at changing it. It appears most are not interested in undertaking the work, and prefer to have their doctor medicate them until death.

Lest I lay no blame on society though, I will say that it has had a hand in creating a generation (or two) of people who think that they are OK, nay, better than OK just the way they are. It may have sprung from the 'free love' movements of the 60's, the 'we own you' ego of the 70's, the 'I'm OK/You're OK' self-esteem exercises of the 80's, or the celebration of the average starting in the 90's. The interest in bettering yourself seems to have disappeared entirely, with the notable exception of increasing one's physical beauty. In this environment, I don't expect that the general populace ever would opt for the steep, rocky and oft-times painful road of self-improvement to attempt to fix their problems, be they social, environmental, or in this case, mental.

After all, they've heard their whole lives that they're a great person, so it can't be their fault that they feel bad . . . and since it's not their fault, it must not be their responsibility to fix it. Better just to take a little pill, and make it all better.

Executive Summary:

Current culture says: If you're unhappy, go change your life; if you're depressed, go take a pill. People are too lazy to do anything about their lives, so they prefer to be lumped in with 'depressed'. Most are also too proud to admit that their brain is broken, and still too lazy to do anything about fixing it. Doctors must choose between letting people be depressed and giving them a pill that distracts them.

Taking a pill only requires the filling of a glass of water.